Roux-En-Y Gastric Bypass

Surgery Overview

Gastric bypass surgery makes the stomach
smaller and causes food to bypass part of the small intestine. You will feel
full more quickly than when your stomach was its original size. This reduces
the amount of food you can eat at one time. Bypassing part of
the intestine reduces how much food and nutrients are absorbed. This leads to
weight loss.

One type of gastric bypass surgery is a Roux-en-Y
gastric bypass.

In normal digestion, food passes through the
stomach and enters the
small intestine, where most of the nutrients and calories are absorbed. It
then passes into the
large intestine (colon), and the remaining waste is eventually
excreted.

In a Roux-en-Y gastric bypass, only a small part of the stomach is used to create a new stomach pouch, roughly the size of an egg. The smaller stomach is connected directly to the
middle portion of the small intestine (jejunum), bypassing the rest of the
stomach and the upper portion of the small intestine (duodenum).

This procedure is done by making several small incisions and using small instruments and a
camera to guide the surgery (laparoscopic approach).

What To Expect After Surgery

You will have some belly pain and may need pain medicine for the first week or so after surgery. The cut that the doctor makes (incision) may be tender and sore.
Because the surgery makes your stomach smaller, you will get full more quickly when you eat. Food also may empty into the small intestine too quickly and lead to dumping syndrome. This can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition.

Your doctor will
give you specific instructions about what to eat after the surgery. For about the
first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. It is important to
try to sip water throughout the day to avoid becoming dehydrated. You may
notice that your bowel movements are not regular right after your surgery. This
is common. Try to avoid constipation and straining with bowel movements.

Bit by bit, you will be able to add solid foods back into your diet. You
must be careful to chew food well and to stop eating when you feel full. This
can take some getting used to, because you will feel full after eating much
less food than you are used to eating. If you do not chew your food well or do
not stop eating soon enough, you may feel discomfort or nausea and may
sometimes vomit. If you drink a lot of high-calorie liquid such as soda or
fruit juice, you may not lose weight. If you continually overeat, the stomach may
stretch. If your stomach stretches, you will not benefit from your surgery.

In a gastric bypass, the part of the intestine where many minerals and
vitamins are most easily absorbed is bypassed. Because of this, you may have a
deficiency in iron, calcium, magnesium, or vitamins. This can lead to long-term
problems, such as osteoporosis. To prevent vitamin and mineral deficiencies,
you may need to work with a dietitian to plan meals. And you may need to take
extra vitamin B12.

Depending on how the surgery was done (open or laparoscopic), you'll have to watch your activity during recovery. If you had open surgery, it is important to avoid heavy lifting or strenuous exercise while you are recovering so that your belly can heal. In this case, you will probably be able to return to work or your normal routine in 4 to 6 weeks. The surgery is most commonly done as a laparoscopic procedure, which means the recovery time is faster.

Why It Is Done

Weight-loss surgery is suitable for people who are severely
overweight and who have not been able to lose weight with diet, exercise, or
medicine.

Surgery is generally considered when your
body mass index (BMI) is 40 or higher. Surgery may
also be an option when your BMI is 35 or higher and you have a life-threatening
or disabling problem that is related to your weight.

It is important to think of this surgery as a tool to
help you lose weight. It is not an instant fix. You will still need to eat a
healthy diet and get regular exercise. This will help you reach your weight
goal and avoid regaining the weight you lose.

How Well It Works

On average, people lose more than half of their excess weight following Roux-en-Y surgery. Ten years after weight-loss surgery, many people have gained 20% to 25% of the weight they lost. The long-term success is highest in people who are realistic about how much weight will be lost and who keep appointments with a medical team, follow the recommended eating plan, and are physically active.footnote 1

Risks

Risks common to all surgeries for weight loss
include an infection in the incision, a leak from the stomach into the
abdominal cavity or where the intestine is connected (resulting in an infection
called
peritonitis), and a blood clot in the legs (deep vein thrombosis, or DVT) or lung (pulmonary embolism). Some people develop
gallstones or a nutritional deficiency condition such
as
anemia or
osteoporosis.

Other risks from Roux-en-Y gastric bypass include:

Stomach pouch problems. You may need a repeat surgery to repair the stomach and/or the opening between the stomach and the intestine.

Vomiting. If you eat more than your stomach can hold, you may vomit.

Hernia. These can be related to the incisions that the surgeon makes or caused by the intestine twisting around itself.

Kidney stones. Drinking enough water can help.

Gallstones. Sometimes
the gallbladder is removed as part of the surgery. But if your gallbladder is
not removed, then you may need to take medicine to prevent gallstones.

What To Think About

Weight-loss surgery does not remove fatty tissue. It is not cosmetic surgery.

Some studies show that people who have
weight-loss surgery are less likely to die from heart problems, diabetes,
or cancer compared to obese people who did not have the surgery.footnote 2

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